ROUNDS TMA wins MACRA improvements, wants more
MEDICINE WON SOME RELIEF in the Centers for Medicare & Medicaid Services’ (CMS’) final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Responding to medicine’s vehement concerns, CMS decided physicians who at least try to comply with the new rules this year will see no penalty in their payments in 2019, the first year the penalties were set to apply. That’s because starting this year, physicians’ performance on various quality, cost, technology use, and practice improvement measures determines cuts or bonuses in their payments two years later. Visit
www.texmed.org/5stepmacraready for the newly updated version of
TMA’s Five-Step Checklist for MACRA Readiness (login required) to ensure your practice is prepared for the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). In addition to reduced reporting requirements under Medicare’s new
Quality Payment Program, TMA and organized medicine won other significant improvements that create a more palatable transition period, including a broader exemption for small practices with few Medicare patients or little revenue from the program. Of TMA’s 50 recommendations to improve MACRA, CMS completely
accepted 21, partially accepted 13, and rejected 16. Among the most significant improvements for 2017:
• A broader exemption that excludes physicians who see fewer than 100 Medicare patients or submit Medicare charges of less than $30,000. The draft rule originally set the low-volume threshold at $10,000.
• Reduced reporting requirements to avoid a penalty in 2019. Any physician who successfully reports one quality measure or one of the new improvement activities this year will earn enough credit to avoid a 4-percent payment cut in 2019.
• A simpler system that gives physicians and groups leeway to pick the most meaningful quality measures and reporting mechanisms for their practices and their patients.
• Eliminating the cost category in calculating physicians’ overall performance scores.
• A shortened performance period that allows physicians to report quality and technology use data for 90 days in 2017, instead of the full calendar year, to be eligible for a bonus.
NEWS FROM AMERICA’S BEST MEDICAL SOCIETY
TMA will continue to work with
CMS and the Texas congressional delegation to rewrite and reform on- going problems identified in the draft regulations that stuck in the final rule. Here’s a list of further improvements TMA would like to see:
• Keep and/or raise the low-volume threshold to exempt physicians from MIPS. Although CMS increased the initially proposed low-volume threshold, many physicians still will have no possibility of a positive re- turn on the investment in the cost of reporting.
• Keep the MIPS performance thresh- old as low as possible for as long as possible. CMS set the MIPS perfor- mance threshold at 3 points, but only for 2017. To reduce the negative im- pact on small practices, CMS should continue to set the composite perfor- mance threshold as low as possible. CMS plans to increase the perfor- mance threshold in 2018, and begin- ning in 2019, will use the mean or me- dian final score from a prior period. Setting the threshold higher results in a larger number of physicians who re- ceive penalties and larger incentive payments to large practices that can absorb the necessary administrative costs to facilitate full compliance and reporting.
• Create and apply a “hold harmless” policy. No payment penalty should be created for and applied to phy- sicians when a technology vendor (electronic health record, registry,
March 2017 TEXAS MEDICINE 15
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